Concurrent pulmonary Aspergillus and non-Aspergillus mold infections in allogeneic hematopoetic cell transplant recipients

Patients with hematologic malignancies and recipients of hematopoietic cell transplantation (HCT) are at high risk for invasive mold infections (IMIs). However, risk factors and clinical manifestations are similar between Aspergillus spp. and non-Aspergillus spp. IMIs. Herein, we describe three HCT recipients who had probable invasive pulmonary Aspergillus and non-Aspergillus co-infections. Antifungal agents were changed to voriconazole in two cases where, ultimately, non-Aspergillus molds were diagnosed after these patients died. Our cases highlight the need for better fungal diagnostics in immunocompromised patients. Clinicians should be aware that Aspergillus spp. and non-Aspergillus spp. IMIs can occur concurrently.